Lege Artis Medicinae

[What is the cause of delay in the diagnosis of the primary sjögren's syndrome?]

ZEHER Margit1, SZEGEDI Gyula1

JULY 29, 1992

Lege Artis Medicinae - 1992;2(07)

[Primary Sjögren's syndrome is the most frequent polysystemic autoimmune disease after rheumatoid arthritis. Keratoconjunctivitis sicca and xerostomia are characteristic of primary Sjögren's syndrome but the evolution of these signs may exist for years, and only one of them may be observed for a long time. Arthritis and enlargement of the parotid and submandibular glands are rarely observed as first symptom. The diagnosis of primary Sjögren's syndrome is based on the evaluation of the obligate signs. Clinical experience shows that there are many patients with undiagnosed Sjögren's disease. The authors would like to demonstrate the importance of the characteristic sings of primary Sjögren's syndrome, and the clinical and immunoserological tests which are useful in the diagnosis of the disease.]

AFFILIATIONS

  1. Debreceni Orvostudományi Egyetem III. Belklinika

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Lege Artis Medicinae

[The role of prostacyclin in the function of the gastric mucosa]

BÁLINT Gábor Sándor

[The intracellular effect of exogenously admi nistered prostacyclin in the gastric mucosa seems to be a polyphasic one, namely: 1. effect on the cyclic nucleotide (CAMP, CGMP) turnover, 2. effect on the calmodulin-content, 3. DNA and RNA changes 4. influence on protein synthesis 5. new cell formation. Besides the endogenous prostacyclin exerts a natural protection against damaging noxae, thus maintaining the physiological integrity of the mucosa. ]

Lege Artis Medicinae

[Clinical principles in the diagnosis and therapy of disseminated intravascular coagulation]

SAS Géza

[Psychologically intravascular coagulation of the blood is hampered by the endothelium, the inhibitors of the coagulation system and the circulation as well. Various pathological events may the diffuse activation of the blood coagulation factors causing disseminated intravascular coagulation. The two main consequences of the DIC are ischaemia in the organs concerned and the consumption of the blood coagulation factors. The activation of the fibrinolytic system improves the former though aggravates the latter pathological events. In the prevention and therapy the effective treatment of the basic disease is of primary importance. Thorough evaluation of the clinical symptoms and the laboratory data can help in the diagnostics. Heparin can be administered only in the hypercoagulative-consumptive forms of the DIC if bleeding does not exist actually. In recent years, the administration of the anti thrombin concentrate has come into prominence because it can promote the restitution of the coagulation system without increase of bleeding. Antifibrinolytic (Gordox) therapy is advised only in cases of extreme hyperfibrinolytic activity. ]

Lege Artis Medicinae

[Laboratory diagnosis of disseminated intravascular coagulation]

HORVÁTH Andrea Rita, MUSZBEK László

[Disseminated intravascular coagulation (DIC) is a highly dynamic process with a broad spectrum of clinical manifestations and laboratory findings. There is no specific laboratory test for the diagnosis of DIC. For the reliable diagnosis of DIC we recommend a test-panel which can be divided into three groups: 1, The screening tests include the measurement of prothrombin time, activated partial thromboplastin time, trombin time, platelet count and detection of fibrin monomers; 2, The diagnosis of DIC can be confirmed with the help of additional assays, such as the determination of fibrin degradation products, antithrombin III or the detection of fragmentocytes in peripheral blood smear; 3, Special tests such as determination of clotting factors, reptilase time, activation peptides and thrombin-antithrombin III complexes may serve as useful tools in the differential diagnosis and in the scientific evaluation of the mechanisms of DIC. In this paper the advantages and disadvantages of different laboratory tests used in the diagnosis of DIC are also critically evaluated. ]

Lege Artis Medicinae

[Tissue banking: possibility and challenge]

CSÖNGE Lajos

[The development of the tissue banking techniques has made possible the production of wide range of differently preserved collagen based tissue grafts (skin, bone, dura mater, fascia lata). Excellent clinical results have been obtained by the application of allogeneic and xenogeneic grafts. The article summarizes the activity fields of tissue banks in the USA and in Europe. The review presents the most important aspects of tissue banking, antigenicity, sterility, preservation and storage of different grafts. ]

Lege Artis Medicinae

[Cardiac Arrhythmia Suppression Trial]

MATOS Lajos

[ Arrhythmia-related death and non-fatal cardiac arrest were 4.5% in the encainide and flecainide group (33 out of 730 patients), compared with only 1.2% in the placebo group (9 out of 725). The relative risk was found to be 3.6%. The overall mortality rate was also higher in the group treated with active agents (7.7%) than among those treated with placebo (3.0%). The relative risk in the latter group was 2.5%.]

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[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

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[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

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